Project Summary: The main cause of behavioral symptoms in patients with Alzheimer's disease (AD) is the deterioration of brain cells which causes a decline in the individual's ability to make sense of the world. Coping with such difficult behaviors is challenging for many caregivers, and it is associated with many distressful situations. Despite current knowledge of adverse effects of dementia on families, dementia caregivers remain the hidden patients with high incidence of stress (59%) and depression (30%). The physical and emotional impact of dementia caregiving is estimated to $9.7 billion in health care costs in the United States (2014). ?In separate studies, hospitalization and emergency department visits were more likely for dementia caregivers who helped care recipients who were depressed, had low functional status, or had behavioral disturbances.? The stress of dementia caregiving is influenced by several factors, such as severity of dementia symptoms, how challenging distressful situations are perceived by caregivers, and available resources. Although information and programs about dementia are available to the public, an essential missing tool is how to deal with difficult behaviors of dementia patients in an effective manner, as they are very common and demanding. This Phase II project will complete the development of the Virtual Patient Behavioral Response (VPBR) training to improve skills on how to respond to dementia behavioral problems and enhance caregiver coping. This training is implemented in a mobile app (Caring Response App, CRA). The expected benefits include improved psychological health in caregivers and reduced stress related to behavioral disturbances of AD patients. Key innovations consist of: (1) integration of virtual patient techniques in a mobile app for dementia caregivers; (2) anonymous sharing of real responses and techniques used by caregivers in day-to-day situations; and (3) automated content update to users through an advanced ?crowdsourcing? of caregiving knowledge (after being ?curated? by project personnel) to promote best practices that caregivers found helpful. Phase I demonstrated the feasibility and met all milestones. Results showed that caregivers were prepared to use the mobile app and it actually reduced their psychological stress. In fact, besides demonstrating usability, acceptance and perceived benefits, Phase I study showed significant positive outcomes for caregivers on reducing their stress, depressive symptoms, and burden of care due to patients? problem behaviors. In Phase II, we will finalize the VPBR curriculum, develop the complete app, and evaluate its effectiveness in a randomized clinical trial; resulting in a novel intervention that integrates virtual patient behavioral response, aggregation of community shared experience, effective training on difficult dementia behaviors, and a mobile app to be deployed to millions of families struggling with Alzheimer?s. Commercial Opportunity: VPBR training will be available to dementia caregivers (16+ Million people in US) as a mobile app subscription. This model has been very successful with our current mobile apps in App Stores.